Predictive value of serum procalcitonin for the localization of acute digestive tract perforation / 中华急诊医学杂志

ABSTRACT

Objective:To investigate the predictive value of serum procalcitonin (PCT) for the localization of acute digestive tract perforation.Methods:This retrospective study included 88 patients from the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Southwest Medical University who were diagnosed as acute digestive tract perforation between January 2015 and January 2018. According to the intraoperative diagnosis and postoperative pathological reports, the enrolled patients were divided into the upper digestive tract perforation group (45 cases) and the lower digestive tract perforation group (43 cases) (above or below Treitz ligament). Preoperative serum PCT, white blood cell, neutrophil rate, C-reactive protein (CRP), albumin (ALB), C-reactive protein to albumin (CRP/ALB) ratio were measured and compared between the two groups. Univariate analysis and multivariate logistic regression analysis were used to analyze the independent risk factors of the lower digestive tract perforation group, and the receiver operating characteristic curve was used to analyze the predictive value of the above mentioned markers in the localization of acute digestive tract perforation.Results:Univariate analysis showed that patients in the lower digestive tract perforation group exhibited significantly higher levels of serum PCT, CRP, ALB, and CRP/ALB ratio than patients in the upper digestive tract perforation group ( P<0.05). Multivariate logistic regression analysis showed that serum PCT, CRP and CRP/ALB ratio were independent risk factors for the diagnosis of lower digestive tract perforation [PCT odds ratio ( OR)=1.241, 95% confidence interval (95% CI) 1.098~1.403, P = 0.001; CRP OR= 0.95, 95% CI 0.912~0.99, P = 0.014; and CRP/ALB ratio OR= 35.104, 95% CI 3.889-316.885, P = 0.002]. The area under curve of serum PCT, CRP, CRP/ALB ratio to distinguish upper or lower digestive tract perforation were 0.932 (95% CI 0.879~0.985), 0.77 (95% CI 0.667~0.872), and 0.898 (95% CI 0.827~0.969), respectively. The optimal cutoff value of PCT in differential diagnosis of upper or lower digestive tract perforation was 16.595 ng/mL, with a sensitivity of 86.0% and a specificity of 91.1%. The optimal cutoff value of CRP was 55.4 mg/mL, with a sensitivity of 76.7% and a specificity of 80.0%. The optimal cutoff value of CRP/ALB ratio was 1.45 and its sensitivity and specificity were 83.7%, 88.9%, respectively. Conclusions:Serum PCT, CRP, and CRP/ALB ratio are helpful to predict the localization of acute digestive tract perforation and can improve the diagnostic accuracy. The diagnostic efficiency of PCT is better than CRP and CRP/ALB ratio, exerting excellent clinical value.